2 Kentucky chemotherapy doctors under investigation

Amber Pike, left, and her son, Gavin Summers, stroll around the family farm in Rineyville, Ky. At 14, Pike was diagnosed with Hodgkin lymphoma and underwent two years of chemotherapy at the Elizabethtown Hematology-Oncology Clinic.(Photo: Dana Rieber, The (Louisville, Ky.) Courier-Journal)

LOUISVILLE — Two doctors accused of padding Medicaid and Medicare payments by prolonging chemotherapy treatments for their patients are under investigation by the Kentucky Medical Licensure Board, according to its general counsel.

Drs. Yusuf Deshmukh and Rafiq Ur Rahman and their Elizabethtown Hematology-Oncology Clinic agreed to pay $3.7 million to the U.S. and Kentucky on June 3 to settle claims that they enriched themselves in part by extending the length of chemo treatments.

Their lawyer, Marc Murphy, said they believed the harmful effects of chemotherapy would be reduced by giving smaller doses during a longer period of time.

But Dr. Donald M. Miller, director of the James Graham Brown Cancer Center in Louisville, said in an interview that there is no therapeutic reason for doing so. He said treatment times are "standardized around the world" and "it is hard to imagine any reason to extend their time."

Dr. Ed Chu, author of Pocket Guide to Chemotherapy Protocols and chief of Hematology-Oncology at the University of Pittsburgh Cancer Institute, said no justification exists for prolonging chemo treatments for patients across the board, as the government says was done at the Elizabethtown, Ky., clinic.

John Caudill, a lawyer for the doctor who filed a whistleblower suit that led to the settlement, said in an interview that the notion that Deshmukh and Rahman were trying to ease the side effects on patients is "absolutely ridiculous."

In an e-mail this week, Murphy noted that neither Miller nor Chu know the facts of the case that resulted in the settlement, which does not involve any admission of wrongdoing or findings that patients were harmed. He noted that the government, after an investigation, agreed to the settlement.

One former patient, Amber Pike, said in an interview that she suffered from agonizing side effects during treatments for Hodgkin's lymphoma that lasted from noon until the evening. Lisa Dunn said her brother, Eric Grech, was administered chemo for eight hours a day, two days a week, then given radiation after the University of Kentucky's Markey Cancer Center found his esophageal cancer had spread throughout his body.

Murphy said Deshmukh and Rahman "reject and deny" those patients' allegations, but he wouldn't comment further, even though Pike and Dunn signed forms waiving patient privacy rules.

The whistleblower suit was filed in 2011 by Dr. Ijaz Mahmood, who left the practice that year. The suit later was adopted by the government under the federal whistleblower act that allows the U.S. to join private suits alleging waste of federal funds.

Unsealed this month, the suit sheds more light on the government's claims that the clinic from 2006 to 2012 extended treatment times for chemo to get higher reimbursements.

According to Mahmood's lawsuit:

• The clinic adopted written guidelines calling for patients to be treated three to four times longer than recommended but in actual practice treated them six to eight times longer.

• Patients were placed on IVs lasting several hours in some instances when all that was medically necessary was for them to receive the chemotherapy drug through a simple injection.

• Clinic staff were told the prolonged treatments were the only "economically feasible way for them to keep their jobs."

Murphy said he wouldn't respond to those allegations because Mahmood's suit was dismissed when the clinic and the government entered into the settlement.

"The allegations, therefore, remain just what they are — allegations," Murphy said.

He noted that the government did not pursue a criminal case against either doctor, nor exclude the clinic from participating in government medical reimbursement programs.

He also said Mahmood filed an unrelated business suit against the clinic in Hardin Circuit Court and that "the law would not consider" him "to be an unbiased witness."

Stephanie Collins, a spokeswoman for the U.S. attorney's office, said she couldn't comment on whether the investigators substantiated all of Mahmood's allegations.

The settlement says the agreement is neither an admission of liability by Rahman and Deshmukh nor a concession by government that its claims are not well-founded.

Caudill said Mahmood, who will collect $283,412 under the whistleblower law, came forward because "he was disturbed by what he had seen and wanted it to stop."

He has his own practice now and declined to comment, Caudill said.

“The allegations, therefore, remain just what they are — allegations.”

Marc Murphy, attorney for Drs. Yusuf Deshmukh and Rafiq Ur Rahman

Leanne Diakov, general counsel for the Kentucky Medical Licensure Board, said it has "open cases" against both doctors but that, under the law, she couldn't elaborate.

Deshmukh and Rahman both graduated from medical schools in Pakistan but have practiced in the U.S. for several decades. Neither has ever been sanctioned by the board.

Publicly available federal records show Deshmukh and Rahman both were in the top 5% nationally for Medicare billings by hematologist-oncologists in 2012, the most recent year for which figures are available.

Deshmukh was paid $1.56 million and Rahman was paid $1.04 million, the records show.

Deshmukh billed 2,766 times for providing additional hours of chemotherapy on 62 patients, while Rahman did so 2,498 times on 54 patients, according to the records.

Murphy, who contributes editorial cartoons to The (Louisville, Ky.) Courier-Journal, said there was no evidence any patient was harmed, but in statements after the settlement U.S. Attorney David Hale said the doctors and their clinic showed "an extraordinary lack of regard for patient welfare." Peter McFarland, inspector general for the U.S. Office of Personnel Management, said what they did was "utterly unconscionable."

Chu, of the University of Pittsburgh, said the extended treatments would have forced patients to spend extra time in infusion rooms and that it could have affected the efficacy of their treatment.